ro13-9904 and Nephrotic-Syndrome

Children with nephrotic syndrome are at increased risk of infections, including bacterial peritonitis, pneumonia, and cellulitis. However, bacterial meningitis, a potentially life-threatening complication, has not been highlighted as an infectious complication of nephrotic syndrome in recent reviews. We report a very subtle and unusual presentation of bacterial meningitis in a child with nephrotic syndrome, which without a high index of suspicion, would have been missed.. A 9-year-old African-American male with a history of steroid-dependent nephrotic syndrome presented to the nephrology clinic for routine follow-up. His medications included mycophenolate mofetil and alternate-day steroids. His only complaint was neck pain and stiffness that the mother attributed to muscle tightness relieved by massage. There was no history of fever, vomiting, headache, photophobia, or altered mental status. On physical examination, he was afebrile (99 °F), but had mild periorbital swelling and edema on lower extremities. He appeared ill and exhibited neck rigidity, and demonstrated reflex knee flexion when the neck was bent. Laboratory evaluation revealed leukocytosis, elevated C-reactive protein, hypoalbuminemia, and proteinuria. Cerebrospinal fluid suggested bacterial meningitis. The patient was treated with ceftriaxone and vancomycin. Both cerebrospinal and blood cultures grew Streptococcus pneumoniae; vancomycin was discontinued. The child completed a 2-week course of ceftriaxone and was discharged home.. A high index of suspicion is necessary in children with nephrotic syndrome treated with corticosteroids, as symptoms may be masked, and thus, a life-threatening disease be missed. Bacterial meningitis should be highlighted as a serious infection complication in children with nephrotic syndrome.

Topics: Ceftriaxone; Child; Humans; Male; Meningitis, Bacterial; Meningitis, Pneumococcal; Nephrotic Syndrome; Vancomycin

There are only few cases of renal pathology induced by Lyme borreliosis in the literature, as this damage is rare and uncommon in humans. This patient is the first case of minimal change glomerular disease associated with chronic Lyme borreliosis.. A 65-year-old Caucasian woman was admitted for an acute edematous syndrome related to a nephrotic syndrome. Clinical examination revealed violaceous skin lesions of the right calf and the gluteal region that occurred 2 years ago. Serological tests were positive for Lyme borreliosis and skin biopsy revealed lesions of chronic atrophic acrodermatitis. Renal biopsy showed minimal change glomerular disease. The skin lesions and the nephrotic syndrome resolved with a sequential treatment with first ceftriaxone and then corticosteroids.. We report here the first case of minimal change disease associated with Lyme borreliosis. The pathogenesis of minimal change disease in the setting of Lyme disease is discussed but the association of Lyme and minimal change disease may imply a synergistic effect of phenotypic and bacterial factors. Regression of proteinuria after a sequential treatment with ceftriaxone and corticosteroids seems to strengthen this conceivable association.

Topics: Acrodermatitis; Aged; Anti-Bacterial Agents; Ceftriaxone; Chronic Disease; Female; Glucocorticoids; Humans; Kidney; Lyme Disease; Nephrosis, Lipoid; Nephrotic Syndrome; Prednisolone; Skin

Topics: Anti-Bacterial Agents; Ceftriaxone; Child, Preschool; Cholelithiasis; Humans; Male; Nephrotic Syndrome

To describe the first case of ceftriaxone-related haemolysis in a patient with congenital nephrotic syndrome (CNS).. Severe haemolysis caused by an immune reaction to ceftriaxone has mostly been described in patients with underlying haematological or immune dysfunction.. The authors present a 20-month-old boy with CNS of the Finnish type with several previous severe infections treated with ceftriaxone, admitted for suspected sepsis. Following ceftriaxone administration he developed shock secondary to an acute haemolytic reaction, with severe anaemia. Hypersensitivity to ceftriaxone was documented through positive agglutination tests.. Onset of haemolysis following ceftriaxone administration, particularly in a patient previously exposed to the drug, must raise the suspicion of a possible immune reaction.

Topics: Anemia, Hemolytic, Autoimmune; Anti-Bacterial Agents; Ceftriaxone; Humans; Infant; Male; Nephrotic Syndrome; Sepsis

Whipple's disease (WD) is a chronic infection caused by Thropheryma whipplei that usually manifests with intestinal, articular, pulmonary, neurological and cardiac abnormalities. Rarely, WD has been associated with renal AA amyloidosis.We report a 50 year-old male with nephrotic syndrome and renal failure whose renal biopsy revealed extensive AA amyloidosis. Amyloid was not found in other organs, namely in gastrointestinal tract and bone marrow. There was no evidence of chronic inflammatory disease, and despite detailed investigation, the diagnosis of the underlying disease remained obscure. Eight months after referral he started peritoneal dialysis. Three years later he developed anorexia, weight loss, anemia, and recurrent attacks of non-bloody diarrhea. A biopsy of the small intestine showed typical histological findings of WD and PCR was positive for T. whipplei. He was treated with ceftriaxone followed by co-trimoxazole, with remission of complaints and histological features. Three years later the patient underwent successful cadaveric kidney transplantation. In this case, AA amyloidosis preceded the manifestations of WD. To the best of our knowledge, this is the first report of kidney transplantation in a patient with amyloidosis due to WD. Recurrence of amyloidosis in renal graft is not expected.

Topics: Amyloidosis; Anti-Bacterial Agents; Ceftriaxone; Duodenum; Humans; Kidney; Kidney Transplantation; Male; Middle Aged; Nephrotic Syndrome; Serum Amyloid A Protein; Trimethoprim, Sulfamethoxazole Drug Combination; Tropheryma; Whipple Disease

Leptospirosis, a disease of protean manifestations occurs sporadically throughout the year with a peak seasonal incidence during the rainy season. We hereby present a case that had clinical features of nephrotic syndrome with massive proteinuria. Leptospirosis was detected on ELISA testing. Patient was cured with antibiotics and diuretics.

Topics: Adult; Ceftriaxone; Enzyme-Linked Immunosorbent Assay; Furosemide; Humans; Immunoglobulin M; Leptospira; Leptospirosis; Male; Nephrotic Syndrome; Proteinuria; Treatment Outcome

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Cellulitis; Diagnosis, Differential; Female; Humans; Meningococcal Infections; Middle Aged; Neck; Neisseria meningitidis; Nephrotic Syndrome; Thigh; Treatment Outcome

Kidney disease is among the clinical manifestations of secondary syphilis, as this case report shows.. During serologically confirmed secondary syphilis, a 63-year-old man developed a nephrotic syndrome diagnosed after biopsy as membranous nephropathy.. Membranous nephropathy is an immunological complication of secondary syphilis. Recovery usually follows treatment. It is often associated with signs that may erroneously suggest connective tissue disease.

Topics: Adrenal Cortex Hormones; Biopsy; Ceftriaxone; Drug Therapy, Combination; Exanthema; Glomerulonephritis, Membranous; Humans; Kidney; Male; Middle Aged; Nephrotic Syndrome; Syphilis; Syphilis Serodiagnosis; Syphilis, Cutaneous